Term
| 43 y/o with CC of lethargy. Increasing fatigue for several months and difficulty concentrating at work. His mood is sad almost q day for the past 3 months and doesn't find enjoyment in hobbies that he used to find pleasurable. He has lost over 10 lbs over the last 2 months and has little appetite and wakes very early every morning. What condition should you suspect? What med would you prescribe, that may cause a SE of sexual dysfunction? |
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Definition
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| 14 y/o boy CC loss of bladder control loss b/c he has been being bullied at school and feels depressed. You r/o organic causes of his enuresis and begin the boy on meds that potentiate the effects of NE and serotonin at the synaptic cleft. What med did you prescribe? |
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Definition
| Tricyclics - Desipramine, Nortriptyline, Imipramine, Amitriptyline, Doxepin |
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Term
| 42 y/o enters your office and appears to be emaciated and is wringing her hands nervously. She relates that she constantly worries about everything in her life, as well as her husband and her children. She has been sleeping poorly and has lost 15lbs over the last 2 months due to her lack of appetite. She admits to having a depressed mood. What is your diagnosis? What med can you give to treat her mood and anxiety as well as stimulate her appetite? |
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Definition
| Generalized Anxiety Disorder; Mirtazapine (Heterocyclic anti-depressant) |
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Term
| 36 y/o with a hx of bipolar disorder presents to the ER c complaints of a HA, palpitations and dehydration. She complains of intense and uncontrollable thirst as well as excessive urination. On PE she appears lethargic with dry skin, dry mucus membranes and a fine hand tremor. Her vitals indicate she is tachycardic and has a BP of 90/50 mmHg. Lab studies show a high serum Na level, high serum osmolality and low urine osmolality. Upon reviewing her med list you suspect that one of her meds being used to treat her bipolar disorder may be causing her symptoms by acting as an anti-diuretic hormone antagonist, which med do you suspect? |
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Definition
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| A 74 y/o pt is admitted initially for pneumonia and is now showing signs of delirium and psychosis. The pt has no relevant hx recorded in her chart, but she tells you she can see her deceased husband standing right in front of her. On exam the pt has fluctuating consciousness, impaired memory and obvious agitation. You decide to order a series of studies to r/o organic causes of her delirium but in the meantime you order a med that will block the postsynaptic dopamine receptors in the limbic system and will hopefully relieve some of her sx. What med do you order? |
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Definition
| Typical Anti-psychotic agents (haloperidol, fluphenazine, chlorpromazine and thioridazine) |
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Term
| 32 y/o pt is brought to the clinic by his wife. He was recently dx with paranoid schizophrenia and his wife tells you that he has become increasingly dependent over the past 2 months and is now unable to care for himself. He continues to hear paranoid voices. On PE, he appears disheveled, cooperative and you notice he has a blunt, flat affect. He denies suicidal or homicidal ideation, but his wife is concerned with his well-being. He is currently being treated with a typical anti-psychotic med. You decide a switch in meds is needed that can treat BOTH the pos and neg symptoms of schizophrenia, what med should you prescribe to meet his needs? What possible SE should you warn the pt of when prescribing this med? |
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Definition
Atypical Anti-psychotic (clozapine, risperidone, olanzapine, ziprasidone, aripriprazole, and quetiapine)
SE - Agranulocytosis (if Clozapine is used) and mild weight gain |
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Term
| A 43 y/o women is brought into the ER by her concerned husband who reports she has been having convulsions. He also reports his wife suffers from alcoholism and she stopped drinking 2 days ago. She has a neg hx for seizures and is on no medications. On PE the pt appears agitated, diaphoretic, and confused. She is tachycardic, HTN and has bilateral hand tremors accompanied by a fever of 100.7F. You immediately start a IV drug that will treat the pts alcohol w/drawl symptoms and you admit her to the hospital for continued monitoring. What med did you prescribe? |
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Definition
| Benzos (Triazolam, midazolam, lorazepam, temazepam, oxazepam, alprazolam, chlordiazepoxide, diazepam, prazepam,clonazepam and flurazepam) |
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Term
| 46 y/o man is brought to the ER after being involved in a serious MVC. The pt is determined to have an isolated head injury and the team determines intubation is necessary. As you prep to intubate the pt, you ask the trauma nurse to administer a med that indirectly potentiates GABA receptor activity and is commonly used for anesthesia induction. What med did you order? |
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Definition
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| 17 y/o female with a history of grand mal seizures presents to your neurology clinic for a f/u visit. She reports she had one seizure which lasted 4 minutes since her appt 1 mo ago. She is currently on 1 med for seizure control, which acts by blocking Na channels on the neuronal cell membrane. Upon further questioning, you discover that the pt is sexually active. You strongly encourage the pt to use OCs as her anti-epileptic is associated with severe birth defects, including growth retardation and congenital cardiac and palate malformations. What med is this pt on? |
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Definition
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| 11 y/o male is brought to your clinic, b/c his mother is concerned about his behavior. The mother describes that the pt will enter a trancelike state for 15 - 30 seconds, where he will stare off into space and is unresponsive to physical or verbal stimuli during this time. After the episodes the patient returns to normal and has no lingering effects. What diagnosis are you thinking? What med is very effective against this dx, and works by reducing the Ca current across neuronal cell membranes? |
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Definition
| Work up for absence seizures; Valproic Acid |
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Term
| 33 y/o pt with a hx of MS presents to your clinic complaining of shooting pains in her face. She tells you that whenever she brushes her teeth or chews vigorously she feels a burst of searing pain on her left cheek. What condition are these symptoms consistent with? What med can be used to treat her symptoms? What must be monitored closely with her use of this med? |
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Definition
Trigeminal Neuralgia
Carbamazepine
Can cause agranulocytosis or aplastic anemia which should be monitored closely using CBC w/diff |
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Term
| 23 y/o with a hx of complex partial seizures presents to your neurology clinic for a f/u visit. He reports that his seizures have been occurring more frequently over the last 4 weeks. This increase in seizure frequency occurred after phenytoin was d/c from his regimen b/c he was not able to tolerate the drug. He is currently taking a high-dose of carbamazepine for seizure control. You decide another anti-epileptic med is indicated to help control his seizure activity and you decide to prescribe one that works by inhibiting the reuptake of GABA in the synaptic cleft. You tell him the new med has SE including N/D and drowsiness, but there should not be any serious SE associated with this new drug like he had experienced with Phenytoin. What drug are you prescribing to this pt? |
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Definition
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Term
| A 43 y/o male is found (by an ambulance service) in severe respiratory failure secondary to status asthmaticus. He is unable to speak and he is quickly tiring from laborious respiration. You decide to perform a rapid sequence intubation at the scene, before bringing the pt to the hospital. In order to perform proper endotracheal intubation, you will require the use of a paralytic agent with rapid onset. You ask the paramedic to administer an agent that is a depolarizing neuromuscular blocker. What med did you administer? What severe SE should you monitor for with this med? |
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Definition
Succinylcholine
Monitor for cardiac arrhythmias and bradycardia |
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Term
| 8 y/o with Cystic Fibrosis is admitted to the hospital for tx of pneumonia. The attending pulmonologist would like to perform a bronchoscopy in order to obtain biopsies and mucous samples which will require the aid of an anesthetic to relax the pt. You must administer a non-depolarizing neuromuscular blocker, which is short acting and easily reversible, which med is appropriate in this situation? |
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Definition
| Pancuronium (Vecuronium , Atracurium, Cistracurium, Tubocurarine, Mivacurium, Rapacuronium) |
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Term
| 31 y/o pt presents to the ER after being involved in a bar brawl at a local establishment. He sustained a deep laceration to his L forearm. You thoroughly clean the wound and confirm there is no residual debris in the wound, and explain to the pt he will need stitches. In order to make sue the pt feels no pain during the procedure you will administer a med locally that will dull his sensation to pain by blocking neuronal Na channels. What med will you administer? |
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Definition
| Local Anesthetic - Procaine, Cocaine, Tetracaine, Benzocaine, Bupivacaine and lidocaine |
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Term
| Within 2 weeks of major abdominal surgery, a 56 y/o male goes into fulminant liver failure and dies. The cause of the liver failure is unknown since he had no signs of liver dx prior to his surgery. Biopsy during autopsy shows massive centrilobular liver cell necrosis. You hypothesize that the pt may have suffered a rare complication of general anesthesia and that the med given, as opposed to a preexisting liver condition was responsible for his death. What med was the cause? |
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Definition
| Halothane - causes fulminant hepatic necrosis (as well as cardiac arrhythmias) |
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Term
| 73 y/o male is brought to the ER complaining of palpitations. An EKG reveals the pt is in V-tach. His BP is 90/60mmHg, so you decide to electrically cardiovert this pt. To prepare the pt for cardioversion you administer a short-acting IV anesthetic agent that acts to prolong activity at the GABA receptor and has a minimal hypotensive effect and possibly chemical pancreatitis. What med will you use? |
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Definition
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Term
| 73 y/o male with metastatic prostate CA is transferred to Hospice for palliative care. Upon transfer from the hospital he was given a prognosis of days to weeks. Upon PE the pt appears to be in severe pain but does not exhibit any signs of respiratory distress. In order to control his pain, you provide the patient with an analgesic that binds to specific receptors in the brain and spinal cord involved in pain transmission. What med did you prescribe? |
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Definition
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| 63 y/o male presents to your clinic complaining of a gradual onset of stiffness in his extremities. He also tells you that he recently noticed a tremor in his R arm. As you are interviewing the pt, you notice the blank expression on his face. Physical exam is significant for cog-wheel rigidity in all extremities, a pill-rolling tremor and a shuffling gait. While ordering further tests, you decide to start the pt on a med that will act to increase the level of dopamine in the brain. What condition is this man suffering from? What med are you prescribing? |
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Definition
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Term
| 19 y/o college student presents to the university clinic complaining of a severe HA. She reports she has a throbbing, pulsatile pain on the left side of her head that started about 3 hours ago and reports she is also feeling nauseous. You learn she has suffered similar HA on and off over the past year. She also tells you she experiences blind spots in her left eye just before the HA comes on. In order to provide acute tx for the attack you administer a med that will stimulate presynaptic 5-HTID receptors in the dura in hopes this will provide symptomatic relief. What med do you prescribe? |
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Definition
| Sumatriptan (Naratriptan, Rizatriptan, Zolmitriptan) |
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Term
| 32 y/o women presents to your clinic for a routine physical exam. Overall she feels well and has no complaints. She has no significant PMH other than tobacco use (10 pk/yr). You strongly encourage her to quit smoking and she is willing to try. Which med can you offer to prescribe to her that has been shown to aid in smoking cessation by acting as a partial agonist (back of card says antagonist) at nicotinic receptors? What other use does this med have? |
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Definition
| Buproprion; It is also an anti-depressant |
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Term
| 35 y/o business professional reports to your clinic concerning tx for his generalized anxiety d/o. He is currently taking Benzos as needed as an anxiolytic. he is concerned about the addictive nature of this med and does not like that he cannot drink alcohol while on his med. What med can you prescribe to fit the needs of this pt? How long will this med take to become effective? |
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Definition
| Buspirone; May take 1 - 3 wks to become effective |
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Term
| 7/6 y/o male with a hx of shingles presents to your clinic c/o R leg pain for the past month. He describes the pain as "sharp pins and needles" feeling over his calf, exactly where he had suffered from shingles. PE is unremarkable and there is no evidence of DVT, Ulceration or cellulitis. What is your dx and how will you tx it? |
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Definition
| Post-herpetic neuralgia; Gabapentin |
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Term
| 14 y/o boy presents to your office for initiation of chemo to treat his acute lymphoblastic leukemia. You explain to the boy and his mother that you will be using several different chemotherapy agents to treat his dx. One of the agents you will be using acts by blocking DNA and RNA synthesis; however, this drug also causes the production of Oxygen free radicals, which can lead to cardiac tissue damage when given at high doses. What drug are you giving this boy? How can you prevent cardiac toxicity from occurring? |
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Definition
| Daunorubicin (Anthracycline); Carefully monitor levels of the drug to avoid cardiac toxicity |
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Term
| 2 y/o boy has recent dx of Wilm's tumor. PE shows a significant L flank mass. You explain to the mom that surgical treatment and chemo is the best course of action for tx. You recommend 2 drugs, one of which acts by inhibiting RNA synthesis. What drug do you recommend? What SE do you have to worry about with this med and how can you prevent this? |
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Definition
Dactinomycin
Bone marrow suppression so CBC w/diff should be monitored closely |
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Term
| 69 y/o man presents with CC of SOB that has worsened progressively over the past month. He has a PMH of a testicular CA dx 4 months ago, for which he is currently on chemo. PE is significant for decreased O2 sat at 89% on RA and decreased air mvment on lung exam. Imaging studies reveal pulmonary fibrosis, which makes you suspect this new lung condition is a SE of the chemo. Which chemo regimen could be the cause? |
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Definition
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| 72 y/o woman presents to ER c/o onset of pain and bleeding with urination over the past 24 hrs. She denies Fever, flank pain or hx of kidney stones. Her PMH is significant for breast CA for which she is currently receiving chemo. UA is significant for copious amt of blood and RBCs. You admit the pt to the hospital and order a urology w/u. What chemo agent might this woman be taking that would lead to this condition? How can you reduce the occurrence of this SE? |
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Definition
| Cyclophosphamide; Reduce by given pt copious amts of fluid and MESNA (Na-2-Mercaptoethane Sulfonate) |
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Term
| 42 y/o man present with c/o severe HA that have been present almost every day for the past month. The pain is usually lateralized to the R side and is often present upon waking. Over the past few days he has also experienced several episodes of projectile vomiting. PE is significant for the presence of papilledema on fundoscopy. You order an MRI and results reveal a malignant mass in the R temporal lobe. This pt will need neurosurgery to remove the tumor and an oncologist for chemo treatment. What chemo tx will be effective against this condition and will work by acting to cross-link DNA strands thereby inhibiting DNA synthesis? |
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Definition
| Nitrosoureas (-mustines & streptozocin) |
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Term
| 76 y/o male c/o ringing in his ears bilaterally that has been present over the past month. He also tells you that he seems to be having increasingly more and more difficulty hearing during this period as well. He has a PMH that is significant for bladder CA and is currently being tx with chemo. PE is remarkable for gross sensorineural hearing loss. You suspect it is the pts chemo med that is causing the hearing deficit and sx. What med is this pt on for his GU tumor? |
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Definition
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Term
| 42 y/o female presents for a f/u for her RA. Her current tx is NSAIDs and steroids, but she is still having severe symptoms. PE demonstrates swelling of the PIP and MCP joints bilaterally, ulnar deviation of the fingers and sub-q nodules over both her elbows. You decide to start the pt on a med that will inhibit dihydrofolate reductase. What med will you use? What is the major SE of this med? |
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Definition
| Methotrexate; Bone marrow suppression, teratogenic and Pulmonary Toxicity |
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Term
| 10 y/o girl presents for her f/u for her ALL for which she is currently on chemo. She was recently DC from the hospital 2 days ago. During her hospital stay the pt developed an episode of acute gout. After this she was put on allopurinol to prevent future gout attacks.Which drug that is very specific to ALL is this pt on? What alterations to the pts current meds should be done? Why? |
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Definition
| 6-Mercaptopurine (Azathioprine); Lowering levels of the chemo drug (by reducing the dosage) will be necessary; Allopurinol inhibits the enzyme that degrades 6-MP so the levels in the blood will rise |
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Term
| 58 y/o male presents to your office for a f/u. He had a recent dx of colon CA and underwent a colon resection. He is currently receiving chemo as an adjuvant tx. On this visit he explains he has noticed photophobia, and oral ulcerations (on lips and mouth). You suspect these findings are likely a SE of the chemo drug being used to tx his colon CA. What chemo med is he on? |
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Definition
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Term
| 36 y/o women presents for her f/u for AML. She has been receiving several chemo agents for the tx of her dx. Her most recent tx involved a cell cycle-specific drug that acts by competitively inhibiting DNA polymerase. She tells you that lately she has been feeling extremely tired and that she has had a nosebleed last week that took a long time to stop bleeding. On PE you note that she is pale, thin women with 3/6 systolic flow murmur at the L upper sternal border and a diffuse petechial rash over her limbs, You send her to the ER for a CBC w/diff. What condition is this women most likely suffering from? |
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Definition
| bone marrow suppression with resulting pancytopenia: SE from Cytarabine |
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Term
| 65 y/o women presents to your oncology clinic for a f/u visit. She was recently diagnosed with small cell carcinoma of the lung 2 months earlier and was started on a chemo regimen at that time. She tells you she has started to lose her hair and that she has been feeling nauseous. You explain that her symptoms are likely related to one of her chemo drugs, which acts by inhibiting DNA topoisomerase II. You then ask her about any GI symptoms and you order serum studies to assess for another common SE. What med is this women on? What is the SE you are assessing for with serum studies? |
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Definition
Etoposide (treats small cell lung carcinoma)
Testing for bone marrow suppression |
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Term
| 21 y/o male presents to the ER complaining of unsteady gait, which he began to notice over the past week. His PMH is significant for dx of Hodgkin's Lymphoma and he is currently on chemo for this dx. PE is significant for hyporeflexia in his lower extremities and R foot-drop. Lab studies are unremarkable and in particular his CBC, platelets and WBCs are WNL. What chemo med could be the cause of his neurologic deficits? |
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Definition
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Term
| 43 y/o female with metastatic breast CA returns to your clinic. She has undergone combo chemo for her metastatic dx without positive response. She is quite upset and asks if her chemo can be changed. You inform her there is a new therapy available for tx of breast CA after failure of combo chemo and that you would like to switch her regimen to this new med which acts by interfering with the ability of the mitotic spindle to break down? |
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Definition
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Term
| 65 y/o woman comes for her annual visit. Her PMH is significant for osteoporosis for which she has been taking alendronate. She tells you she has been experiencing significant symptoms consistent with GERD since beginning the alendronate. You send the pt for a Upper Endoscopy which reveals esophageal ulcerations. You determine that these findings may be caused by her alendronate, so you d/c the med and begin a new med regimen that acts as a mixed estrogen agonist and antagonist. What new med are you using? |
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Definition
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Term
| 49 y/o male presents to oncology for f/u of his CML dx, for which he has been currently receiving chemotherapy. You ask whether he has experienced any N/V/D, all of which are common SE of his chemo meds. His blood tests are on the low end of normal, which is to be expected as his chemo drug can cause bone marrow suppression. You explain to the pt his drug is working by inhibiting ribonucleotide reductase, an enzyme involved in making deoxyribonucleotides, the building blocks of DNA. What chemo med is this pt on? |
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Definition
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Term
| 50 y/o female returns to your oncology clinic for a f/u visit. She is currently on a multi-drug regimen for metastatic breast CA. She appears to be responding well after the addition of another chemo agent aimed at the HER-2/neu receptors within her CA cells. While she is in your office, you schedule an imaging study to evaluate her heart. What med is this pt on that is highly effective against her breast CA type? Why are the cardiac imaging studies necessary with this med? |
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Definition
| Trastuzumab; This med is cardiotoxic in some pts |
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Term
| 64 y/o male with CML is being seen in your oncology clinic. He has been treated with alpha-interferon and cytarabine with no improvement. He wants to know if there are other options to treat his dx. You tell him there is a new drug approved by the FDA as a first-line treatment for CML that acts by inhibiting a tyrosine kinase on a mutated gene product, bcr-abl, associated with his disease. What med are you recommending? |
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